Disclaimer: This is general medical information and not specific medical advice. It does not and should not replace diagnosis or treatment by your healthcare provider. If you are seeking personal recommendations, advice, and/or treatment, please consult your physician. If you have an emergency, you should contact 911 or go to the nearest Emergency Room.
August 21, 2019 - It seems like everyone, their grandparents, and their next-door neighbors have been talking about CBD oil! We’ve received several questions about CBD oil use during pregnancy and decided to dive into the facts.
What’s the difference between CBD and THC?
CBD (cannabidiol) and THC (tetrahydrocannabinol) are 2 out of about 80 active compounds, or phytocannabinoids, found in the marijuana (cannabis) plant. While THC is a psychoactive, hallucinogenic agent that can provide a “high” and feelings of paranoia, non-psychoactive CBD gives users a calm, relaxed sensation. CBD and THC both act on the appetite-, energy-, and mood-regulating endocannabinoid system in the brain, but work on two different receptors, CB1 and CB2, to have slightly different effects.
Source: Leaf Science
On a basic level, CBD and THC alter the transmission of neurotransmitters in a way that’s been shown by research studies as well as anecdotal accounts (ie, your Facebook friends) to ease conditions such as chronic pain, anxiety, and nausea. CBD and THC are currently being studied as treatments for neurological disorders (including Alzheimer’s, Parkinson’s, and multiple sclerosis) as well as psychiatric and mood disorders.
The scientific evidence for phytocannabinoids’ effectiveness for certain conditions is growing - but the problem is that CBD oil use has not been studied long term nor proven safe for pregnant individuals specifically.
Is CBD oil legal? Is it safe?
As you may have guessed by CBD oil’s sudden ubiquity, it is legal - sort of. The major factor that determines CBD’s legality is its source, since CBD can be derived from either marijuana or hemp, both varieties of the Cannabis sativa plant. Hemp is a legal term referring to varieties of cannabis that contain less than 0.3% THC as a mature plant, while marijuana includes varieties with a THC content of 20% or greater.
As of August 2019, the legality of CBD oil in the United States is complicated. Marijuana-derived CBD is subject to federal and state legislation that applies to all marijuana products (illegal on a federal level, but legal in certain states - you can read about your state’s laws here and here). Hemp-derived CBD, on the other hand, was legalized in all states after the passage of the 2018 Farm Bill, which passed in large part due to consumer support for hemp-based CBD products.
A map of states organized by legal "friendliness" to CBD products. (Source: Marie Claire)
Regarding safety, CBD oil is currently sold and regulated at the same level as a supplement or vitamin - which is to say, without FDA oversight. It is an unregulated market with quality definitely not assured. CBD oil is extracted from the oily resin of cannabis plants, and the quality of methods for this extraction is variable. Cheaper products may have contaminants that could even include THC (detectable by marijuana-specific drug tests, whereas CBD is not). Mislabeling is also rampant. One study published in the Journal of the American Medical Association (JAMA) showed that only 31% of CBD products purchased online actually contained the labeled amount of CBD, with the rest either over- or under-labeled. Shockingly, THC was detected in 21% of these products, despite this not being noted on the packaging.
What do doctors say about CBD oil and pregnancy?
Physicians are generally wary of CBD oil use in pregnancy for a few reasons.
First, apart from anecdotal evidence of CBD’s usefulness for treating pregnancy-induced nausea and vomiting, there have been no studies showing that CBD has positive treatment outcomes specifically for pregnancy symptoms without negative side effects for either pregnant individuals or their babies. There are also concerns about the impact on children following prenatal exposure to marijuana.
Second, regular use of THC-containing marijuana in pregnancy has been proven by multiple studies to have adverse outcomes for pregnant individuals and their babies, primarily decreased infant birth weight and a slightly increased risk of stillbirth. THC can affect fetuses and newborns because its lipid-soluble structure allows it to cross the placenta, and it’s also transmittable in breast milk. The American College of Obstetricians and Gynecologists strongly discourages marijuana use during pregnancy for these reasons.
Third, the lack of quality control of the CBD market means that it’s difficult to know what’s in the CBD products you’re buying.
In other words, the potential risks of CBD use during pregnancy do not outweigh the potential benefits. It is unlikely that the American College of Obstetricians and Gynecologists will ever recommend or endorse CBD oil use during pregnancy before the completion of a clinical trial studying its long term effects on pregnant individuals and their children. Now that hemp-based CBD products have been legalized at a federal level, it’s more likely that such a clinical trial could happen in the future, but there is not one currently in progress.
So what should I do? Bottom line:
The convenience and ease of ordering hemp-based CBD oil online and the growing social acceptance of its usage should not be confused with medical approval.
If you are still strongly interested in CBD oil use during pregnancy, it is absolutely something to discuss with your provider on a personal basis. If you have already used CBD oil before or during pregnancy, it is best to share this with your doctor, as CBD oil has been shown to interact with other medications such as blood thinners. Don’t be embarrassed - sharing this information will ensure that your physician is able to provide you with informed care.
Our founder, Dr. Taraneh Shirazian, says, “Please understand that the use of CBD oil has not been tested in pregnancy or in women trying to get pregnant. We therefore don’t know the effects on the developing fetus and should be careful about what we put on our bodies and what we ingest.”
Jade Cohen is a Mommy Matters medical student contributor.